Healthcare Provider Details

I. General information

NPI: 1952864845
Provider Name (Legal Business Name): MISS KALEIGH TIMMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

20 CENTRAL AVE FL 3
LYNN MA
01901-1201
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax:
Mailing address:
  • Phone: 781-596-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number291889
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: